Bills attempting to address rural healthcare challenges in the state are mostly reaching the governor’s desk.
This includes a bill that outlines the state's requirements for using federal healthcare funds. But senators say there’s a chance the feds will reject it, and lawmakers will have to come back for a special session.
In the past couple of months, 11,000 Wyomingites have dropped off the Affordable Care Act marketplace due to prices skyrocketing since subsidies for monthly premiums were not extended. Plus, a recent report found that six out of 30 hospitals in the state are in immediate jeopardy of closing, and three are on the verge.
Over the summer, the Joint Labor, Health and Social Services Committee studied these issues. They sponsored five bills meant to help. Four of those have made it to the governor’s desk.
HB 4 allows birthing centers to apply for Medicaid reimbursement. These centers offer a delivery option that’s in-between having a baby in a hospital and having one at home. This was the first bill Gov. Mark Gordon signed this session.
SF 4 increases the state’s portion of Medicaid reimbursement for EMS services to 100% using a $1.3 million appropriation from the state’s general fund with an equal federal match. By increasing the state reimbursement rate, EMS services will get paid more money to recoup their costs for the next two years. The governor has yet to sign this bill.
SF 6 codifies current Medicaid requirements for Wyomingites, in addition to adopting new federal regulations. The One Big Beautiful Bill Act, signed into law last July, requires many Medicaid recipients to work or participate in qualifying activities for 80 hours per month unless they meet exemptions for disability, pregnancy, caregiving or other circumstances.
The Wyoming-specific requirements outlined in the law are that the individual applying must be a U.S. citizen with proof of identity and a Wyoming resident. An individual must also be eligible for one of the additional outlined criteria, including: being disabled according to Social Security guidelines, receiving Supplemental Security Income or being entitled to hospice services, among others.
The law also requires prior authorization from the state Legislature if the federal government expands eligibility requirements after July 1, 2026. The governor has signed it into law.
SF 5 allows county memorial hospitals and hospital districts to file for bankruptcy under Chapter 9 of the United States Bankruptcy Code. For a memorial hospital, the filing must be approved by the board of county commissioners, while a hospital district must post the bankruptcy petition and plan on any website operated by the district for at least seven days before the first public meeting, when the petition and plan will be considered. The governor has signed it into law.
Two more bills sponsored by Rep. Ken Clouston (R-Gillette) failed to be introduced. They would have increased Medicaid reimbursement rates for nursing homes and maternal health services to help ensure healthcare facilities and workforce are properly reimbursed for the services they provide.
Rural Health Transformation funds
When Clouston’s bills were discussed, some lawmakers referred to the $205 million in federal funds the state will receive from the Rural Health Transformation Program as a reason that these reimbursements were not needed.
“I think there was some confusion,” said Eric Boley, president of the Wyoming Hospital Association. “We need to draw really distinctive lines between what Rural Health Transformation [Program] funds can be used for and what Medicaid reimbursement can be used for. I think we missed the boat, but I'm sure it'll come back. I think it's an important conversation to have.”
Boley says the rural health funds must be used for the priorities the Wyoming Department of Health (WDH) identified in its application, which was approved late last year.
A bill that will codify how federal Rural Health Transformation Program funds can be used in the state passed the House and Senate and now awaits the governor’s signature or veto.
The bill would create a Wyoming rural health transformation program within WDH, plus an advisory committee and a perpetuity fund. The perpetuity fund will take a percentage of the federal money the state receives annually and invest it. According to WDH’s director, this is meant to make the program more sustainable than the five years the federal government has outlined for it.
WDH would be able to take money out of the fund each year for four outlined purposes: critical access hospitals, emergency medical programs, individual healthcare workforce education awards and individual support for physician post-graduate medical education.
The Centers for Medicare and Medicaid Services (CMS) must agree on how the state wants to use the funds. The agency is in negotiations with WDH to hash out the details of how the state plans to do what’s outlined in its application.
Sen. Charles Scott (R-Casper) introduced an amendment that would allow the governor to change the state's requirements to align with whatever the federal government agrees to with WDH.
Lawmakers didn’t mention specifically which elements of the negotiations are high-stakes.
However, during floor discussion on the amendment, Scott himself asked senators to vote against it.
“A few minutes before we convened, we got word from one of my colleagues [who] brought it, and he may well want to speak to this, that the governor thinks that the amendment might undermine his negotiating position,” said Scott. “And that's important. If the negotiating position is a high-stakes one, we're prepared to walk away if they don't agree, then the amendment might undermine that.”
Other senators agreed with Scott on the floor, acknowledging that if the bill passes without the proposed amendment and if WDH doesn’t come to an agreement with CMS, lawmakers will have to convene for a special session to rectify the differences.
“By taking this [amendment] out, leaving it the way it is now, may very well mean we have to come back,” said Sen. Mike Gierau (D-Jackson). “But it gives the folks in our Department of Health and on the first floor the best possible position to negotiate what's actually a very tricky negotiation, with a very large amount of money…. that are very, very important to the long-term future of this state.”
The amendment failed, and the bill passed third reading by 26 to 5. It now awaits the governor’s signature.
Boley said he’s hopeful that these funds will help hospitals and healthcare become more attainable and sustainable in the state. If negotiations succeed, Wyoming will receive $205 million in the first year of the program.
